CCL: DC time p/ Manual Hold vs Closure

[candyndel]

I have noticed the many differences amongst various cath labs and am surveying...

Please let me know what your institutional policy is re: ambulation/DC time in hours after a manual hold vs closure devices.

THANKS IN ADVANCE!!!

If anyone has a policy they would like to share, I would greatly appreciate that as well!

[dianah, ASN]

It all depends, of course, on the type of closure device/assist device used, if there was any difficulty gaining access and each patient's state of coagulability.

Our practice is:

AngioSeal or StarClose: 2 hr bedrest, may have HOB up 30 degrees, keep affected leg straight and head on pillow.

Clo-Sur P.A.D.: 3 hr bedrest (usually; 4 hr may be ordered, see below), may have HOB up 30 degrees, keep affected leg straight and head on pillow.

After the requisite 2 (or 3) hours, pt may ambulate in the room, the nurses observe for any hematoma. If VS are stable, distal pulses unchanged, pt feels well and no hematoma at site, outpts may be discharged (could be within 1/2 hr after the 2hr of bedrest).

We use Clo-Sur P.A.D. for all manual holds, so we will rarely have a pt lie 'flat' for 6 hr (it HAS been ordered, though, because the MD was concerned about bleeding: pt moves or coughs a lot, lots of oozing or hematoma occurring during case, many sticks to obtain access, etc. One pt joked a lot and his constant laughing, we think, contributed to formation of a hematoma!)

We do diagnostic caths only, no interventions, so don't deal w/pts on integrilin or high ACTs.

Hope this helps. :)